Medreview
MedReview LLC is a leading medical and health claims auditing firm established in 1998. They specialize in medical claims audits, pharmacy audits, and dependent eligibility audits to help self-insured plan sponsors reduce healthcare costs. Their services include focused sample claim audits, random sample claim audits, pharmacy audits, and dependent eligibility audits. MedReview works with a broad client base including Fortune 1000 companies, medium-sized organizations, non-profits, Taft Hartley, and government organizations. They are committed to ensuring claims are processed correctly, overpayments are recovered, and plan assets are safeguarded.
Industries
Nr. of Employees
medium (51-250)
Medreview
Thomasville, Georgia, United States, North America
Services
Targeted auditing of claims selected from a comprehensive query of paid claims to identify overpayments and systemic issues; includes onsite file review, full-file testing of validated errors, operational overview of administrator, and post-audit support.
Statistically based audits using stratified random sampling across the paid claims population, with electronic claims extract analysis, sample testing, and extrapolation to estimate population financial impacts.
Comprehensive review of prescription drug claims and PBM performance to verify adherence to contract terms and plan provisions, including pricing, discounts, rebates, dispensing fees, copay handling, and days' supply rules.
Verification of enrolled dependents through documentation collection and validation, customized employee communications, and production of legal documentation to mitigate fiduciary risk and control plan costs.
Assessment of third-party administrator systems, policies, and standard operating procedures to determine alignment with plan documents and to identify systemic issues that affect claim payment accuracy.
Targeted auditing of claims selected from a comprehensive query of paid claims to identify overpayments and systemic issues; includes onsite file review, full-file testing of validated errors, operational overview of administrator, and post-audit support.
Statistically based audits using stratified random sampling across the paid claims population, with electronic claims extract analysis, sample testing, and extrapolation to estimate population financial impacts.
Comprehensive review of prescription drug claims and PBM performance to verify adherence to contract terms and plan provisions, including pricing, discounts, rebates, dispensing fees, copay handling, and days' supply rules.
Verification of enrolled dependents through documentation collection and validation, customized employee communications, and production of legal documentation to mitigate fiduciary risk and control plan costs.
Assessment of third-party administrator systems, policies, and standard operating procedures to determine alignment with plan documents and to identify systemic issues that affect claim payment accuracy.
Expertise Areas
- Medical claims auditing
- Pharmacy benefits auditing and PBM contract review
- Dependent eligibility verification
- TPA operational and compliance reviews
Key Technologies
- Stratified random sampling
- Claims data ETL and analytics software
- Statistical extrapolation of sample results
- Eligibility verification procedures
News & Updates
Recent audits have uncovered significant payment errors including hospital claims paid in full that should have been discounted, unauthorized inpatient rehab claims paid, and claims paid for ineligible dependents, leading to recoveries for clients.
Highlights the importance of self-funded plan sponsors conducting audits to meet regulatory requirements, control costs, and verify claims processing.
Recent audits have uncovered significant payment errors including hospital claims paid in full that should have been discounted, unauthorized inpatient rehab claims paid, and claims paid for ineligible dependents, leading to recoveries for clients.
Highlights the importance of self-funded plan sponsors conducting audits to meet regulatory requirements, control costs, and verify claims processing.